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  • Burrhole Versus Craniotomy for the Treatment of Chronic Subdural Hematoma: A Matched Cohort Analysis

    Final Number:

    Gabriel Alexander Smith MD; Matthew Rogers BS; Madeline Greil Medical student; Andrew E. Sloan MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Chronic subdural hematomas (cSDH) represent one of the most common neurosurgical disorders with a prevalence of 5/100,000 in the general population. cSDH can present with a variety of complaints which may include headaches, ataxia, hemiparesis, seizures, drowsiness, or speech impairments usually following a subacute course after a head injury. Burr-hole craniostomies have been the standard of care with the rate of recurrence is 5-15% - particularly when there are loculations. Our hypothesis was that “mini-craniotomies” may be more effective. We performed a matched cohort analysis of patients of burrhole craniostomy versus craniotomy drainage of chronic subdural hematomas to evaluate efficacy of each approach.

    Methods: A retrospective chart review of 200 cSDH that presented to University Hospitals Case Medical Center between 2006 and 2015 was performed. One hundred craniotomy and 100 burrhole craniostomy patients were identified and a matched cohort analysis was performed. Data on demographics, co-morbidities, coagulopathy, neurological status, radiographic findings, disposition, and mortality were collected. Primary endpoints were rehemorrhage, reoperation, and need for additional adhesolysis in during the second operation.

    Results: There were no significant differences in the main outcomes studied. Rate of rebleed was 17% versus 6.9% for burrhole and craniotomies respectively, (p=0.071). Rate of reoperation was 16% and 10% for burrhole and craniotomy groups (p=0.322). The need for additional adhesolysis was 14% and 17% for burrhole and craniotomy groups (p=0.084). Univariate and multivariate analysis on age, gender, coagulopathy, anticoagulant or antiplatelet use, GCS score, and pre-operative imaging factors yielded no significant correlation to outcomes (all p>0.05).

    Conclusions: Univariate and multivariate analysis yielded no statistically significant difference between the two cohorts for rehemorrhage, reoperation rates, or adhesolysis. We conclude that the choice of burrhole or craniotomy should be chosen on a case by case basis at the discretion of the surgeon.

    Patient Care: 1. Surgical approach decision-making for cSDH can be cone on a case by case basis 2. No difference in outcome can be reinforced with our data.

    Learning Objectives: 1. Patient selection is critical to choosing which operation to perform for cSDHs. 2. No difference between operation chosen in regard to need for second operation or rebleed rates.

    References: 1 Altinel, F., Altin, C., Gezmis, E. & Altinors, N. Cortical membranectomy in chronic subdural hematoma: Report of two cases. Asian journal of neurosurgery 10, 236-239, doi:10.4103/1793-5482.161184 (2015). 2 Garber, S., McCaffrey, J., Quigley, E. P. & MacDonald, J. D. Bedside Treatment of Chronic Subdural Hematoma: Using Radiographic Characteristics to Revisit the Twist Drill. Journal of neurological surgery. Part A, Central European neurosurgery, doi:10.1055/s-0035-1570128 (2016). 3 Huang, K. T. et al. The Neurocritical and Neurosurgical Care of Subdural Hematomas. Neurocritical care, doi:10.1007/s12028-015-0194-x (2015). 4 Javadi, S. A., Naderi, F. & Javadi, A. M. The Optimal Surgical Approach for Treatment of Chronic Subdural Hematoma: Questionnaire Assessment of Practice in Iran and Review of Literature. Acta medica Iranica 53, 617-621 (2015). 5 Lee, K. S. Chronic Subdural Hematoma in the Aged, Trauma or Degeneration? Journal of Korean Neurosurgical Society 59, 1-5, doi:10.3340/jkns.2016.59.1.1 (2016). 6 Phang, I., Sivakumaran, R. & Papadopoulos, M. C. No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma. Annals of the Royal College of Surgeons of England 97, 584-588, doi:10.1308/rcsann.2015.0042 (2015). 7 Wang, Q. F., Cheng, C. & You, C. A New Modified Twist Drill Craniostomy Using a Novel Device to Evacuate Chronic Subdural Hematoma. Medicine 95, e3036, doi:10.1097/md.0000000000003036 (2016).

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